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C V <br />^2 <br />( <br />£ <br />kdc, <br />- M, \L_L <br />Q. <br />M \L,' Q P - <br />Temperature Temperatureitem / Location <br />(-A <br />Safety Certification <br />Name:ppm <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:°FPpm <br />Phone: <br />Time Out: <br />EHD 16-24 (2^ pg) 4/3/13 <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/ehd <br />__2c\2OJZ_ <br />Program Record: <br />Permit Posted <br />Warewashing <br />Heat: <br />\<\ <br />2jG <br />Received By/Title: <br />EHs^iaiis<e^^2L^ <br />Time in: <br />4|F <br />5a F <br />MOr <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />t krpr____________ <br />Hbr <br />V?O '2- <br />MQr ______ <br />Facility Hot Water Temperature <br />Hand Sink: <br />°F <br />bvirr So ay <br />\2 2<J Page <br />FOOD PROGRAM 0IR CONTINUATION <br />°F <br />(v/s? 2MF <br />Yes No <br />Owner/Operator: <br />Program Element: \ "S <br />SB180 Posted Yes No <br />jre <br />cp Chlorine: <br />_____________Food Program Official Inspection Report______ <br />Name of Facility: \\ x Q ___________________________________________Date: t Q • \ 2 ‘ 2 <br />Address:____ju_____ City; (. -VVk Zip Code:____________________ <br />• Telephone: <br />Inspection Type:— <br />Re-Inspection on or After: <br />Item/Locatlon <br />n <br />w — <br />G> feO - ^ \ F <br />Clty: <br />c o <br />ip F E < <br />Pr\\